CHAPTER 5POISONING, DRUG ABUSE, AND HAZARDOUSMATERIAL EXPOSUREAs a Hospital Corpsman, you may encounterpatients as the result of poisoning, drug overdose, orexposure to hazardous materials. Such patients mayinitially present with no symptoms or with varyingdegrees of overt intoxication. The asymptomaticpatient may have been exposed to or ingested a lethaldose of a substance but not exhibit any manifestationsof toxicity. A patient with mild symptoms maydeteriorate rapidly, so observe them closely.Potentially significant exposures should be observedin an acute care facility whenever possible.Remember, though: We are not always in a hospitalenvironment, and we must be prepared to deal witheach situation when and wherever it should presentitself.In this chapter, we will discuss the assessment andtreatment for ingested, inhaled, absorbed, and injectedpoisons. Drug abuse assessment and treatmentprocedures, patient handling techniques, and therecognition of hazardous material (HAZMAT)personal safety guidelines and information sourceswill also be covered. The last part of the chapter willcover rescue, patient care, and decontaminationprocedures for patients exposed to HAZMAT.NOTE: Prior to deployments and operationalcommitments, commands are stronglyr e c o m m e n d e d t o c o n t a c t t h e a r e aEnvironmental Preventive Medicine Unit(EPMU) for current, specific, medicalintelligence, and surveillance data. With thisinformation at hand, the local preventivemedicine authority can identify, prevent, andtreat conditions not common to the homeportarea. The cognizant EPMU will provide datathrough MEDIC, (Medical, Environmental,D i a g n o s i s , I n t e l l i g e n c e a n d C o u n t e r-measure). Formally called aDisease RiskAssessment Profile (DISRAP), MEDIC is ac o m p r e h e n s i v e , c o n s t a n t l y u p d a t e dmanagement tool. MEDIC is an invaluableaid for identifying at-risk communicablediseases, immunization requirements, and—as applies especially to this chapter—localpests and environmental dangers.POISONINGLEARNING OBJECTIVE:R e c a l lassessment and treatment procedures foringested, inhaled, absorbed, and injectedpoisonsA poison is a substance that, when introduced intothe body, produces a harmful effect on normal bodystructures or functions. Poisons come in solid, liquid,and gaseous forms, and they may be ingested, inhaled,absorbed, or injected into the system.Every chemical in a sufficient dose can cause toxiceffects in a human—or in any organism. The amountor concentration of a chemical and the duration ofexposure to it are what determine the chemical’s doseand toxicity. A 16th century quotation from Paracelsusstates, “Dose alone makes a poison. . . .All substancesare poisons, there is none which is not a poison. Theright dose differentiates a poison and a remedy. ”A poisoning is defined as the presence of signs orsymptoms associated with exposure or contact with asubstance. If there are no clinical manifestations ortoxic effects, the incident is simply an “exposure” or acontact with a potentially poisonous substance. Justbeing exposed to a chemical does not mean that apoisoning has or will occur. It is a matter of dose anda few other variables (e.g., age, sex, individualresistance, or state of health) that determine if, or what,toxic effects will occur.ASSESSMENT AND TREATMENTOF PATIENTIn most cases, ASSESSMENT AND TREATMENTOF THE PATIENT IS MORE IMPORTANT THANEFFORT TO IDENTIFY AND TREAT A SPECIFICPOISON. Supportive therapy—managing the ABCs(Airway, Breathing, and Circulation) of basic lifesupport and treating the signs and symptoms—is safeand effective in the vast majority of poisonings.Extraordinary means to enhance elimination of thepoison (hemodialysis and hemoperfusion) are seldomneeded. Except for agents with a delayed onset of5-1
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